Nonaccommodative convergence excess is a condition in which a patient has orthotropia or a small-angle esophoria or esotropia at distance and a large-angle esotropia at near, not significantly reduced by the addition of spherical plus lenses. The AC/A ratio, determined with the gradient method, is normal or subnormal. Tonic convergence is suspected of causing the convergence excess in these patients. Nonaccommodative convergence excess must be distinguished from esotropia with a high AC/A ratio and from hypoaccommodative esotropia. In 24 patients treated with recession of both medial recti muscles with and without posterior fixation or by posterior fixation alone, the mean correction of esotropia was 7.4 prism diopters at distance and 17 prism diopters at near.